Extracorporeal Membrane Oxygenation for the Support of Adults With Acute Myocarditis
Extracorporeal Membrane Oxygenation for the Support of Adults With Acute Myocarditis
复制标题
DOI：
10.1097/ccm.0000000000000920
复制
发表时间：
2015-05-01
影响因子：
8.8
通讯作者：
Thiagarajan, Ravi R.
中科院分区：
文献类型：
--
作者：
Diddle, J. Wesley;Almodovar, Melvin C.;Thiagarajan, Ravi R.
目的：分析成人急性心肌炎患者行体外膜肺氧合治疗后的生存情况，确定院内死亡的危险因素。设计：对体外生命支持组织登记数据库进行回顾。背景：230个体外膜肺氧合中心向体外生命支持组织报告的数据。患者：1995-2011年间16岁或以上的患者接受体外膜肺支持治疗心肌炎。干预：无。测量和主要结果：从1995年到2011年，在体外生命支持组织数据库中，147例确诊为急性心肌炎的患者进行了150次不同的体外膜肺治疗。出院存活率为61%。9例患者接受了心脏移植，无移植存活至出院的比例为56%。31例患者(占队列的21%)在体外循环心肺复苏期间进行了体外膜肺氧合。在评估体外膜氧合和体外膜氧合支持因素的多变量模型中，体外膜氧合停止(调整后的优势比，2.4；95%可信区间，1.1-5.0)和体外膜氧合插管后4小时需要更高的体外膜氧合流量(优势比，2.8；95%可信区间，1.1-7.3)与住院死亡率增加相关。在评估体外膜肺氧合不良事件的第二个多变量模型中，中枢神经系统损伤(优势比，26.5；95%可信区间，7.3-96.6)，肾功能衰竭(优势比，3.6；95%可信区间，1.4-9.3)，心律失常(优势比，5.8；95%可信区间，2.2-15.1)，以及高胆红素血症(优势比，9.1；95%CI，2.6~31.8)与院内死亡率增加有关。结论：体外膜肺氧合可有效地支持成人心肌炎患者在等待心肌恢复期间的循环。在心脏骤停前及早进行体外膜肺氧合可能与较好的预后相关。
Objectives: To characterize survival outcomes for adult patients with acute myocarditis supported with extracorporeal membrane oxygenation and identify risk factors for in-hospital mortality.Design: Retrospective review of Extracorporeal Life Support Organization registry database.Setting: Data reported to Extracorporeal Life Support Organization by 230 extracorporeal membrane oxygenation centers.Patients: Patients 16 years old or older supported with extracorporeal membrane oxygenation for myocarditis during 1995 to 2011.Interventions: None.Measurements and Main Results: There were 150 separate runs of extracorporeal membrane oxygenation for 147 patients with a diagnosis of acute myocarditis in the Extracorporeal Life Support Organization database from 1995 through 2011. Survival to hospital discharge was 61%. Nine patients underwent heart transplantation, and transplant-free survival to discharge was 56%. Extracorporeal membrane oxygenation was deployed during extracorporeal cardiopulmonary resuscitation in 31 patients (21% of the cohort). In a multivariate model evaluating pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation support factors, pre-extracorporeal membrane oxygenation arrest (adjusted odds ratio, 2.4; 95% CI, 1.1-5.0) and need for higher extracorporeal membrane oxygenation flows at 4 hours post-extracorporeal membrane oxygenation cannulation (odds ratio, 2.8; 95% CI, 1.1-7.3) were associated with increased odds of in-hospital mortality. In a second multivariate model evaluating adverse events while on extracorporeal membrane oxygenation, central nervous system injury (odds ratio, 26.5; 95% CI, 7.3-96.6), renal failure (odds ratio, 3.6; 95% CI, 1.4-9.3), arrhythmia (odds ratio, 5.8; 95% CI, 2.2-15.1), and hyperbilirubinemia (odds ratio, 9.1; 95% CI, 2.6-31.8) were associated with increased odds of in-hospital mortality.Conclusions: Extracorporeal membrane oxygenation can be used effectively in adults with myocarditis to support the circulation while awaiting myocardial recovery. Early extracorporeal membrane oxygenation deployment prior to cardiac arrest may be associated with better outcomes.